Parental and own substance use disorder: The intersection of gender and early adversity.

BACKGROUND: Children who are exposed to parental substance use disorder (SUD) have a higher risk of SUD themselves. This study examines the extent to which the association between parental and own SUD is conditional upon childhood trauma, socioeconomic status, and gender. METHODS: This study uses data from the Nashville Stress and Health Study with 1234 respondents ages 25-65 collected from 2011 to 2014, weighted be representative of the general population. The association between parental SUD and own SUD was estimated using Cox Proportional Hazard Models, controlling for covariates, and testing for interactions. RESULTS: Other things being equal, the risk of own SUD is more strongly associated with parental SUD in households with childhood traumas among men, but not women. Childhood trauma is not associated with own SUD in the absence of parental SUD among men. For men with parental SUD exposure, just one traumatic event is associated with a 38% increased risk of own SUD (HR=1.382, SE=.201, p < 0.05). For men, living with grandparents is associated with added SUD risk (HR=1.476, SE=.228, p < 0.05). For women, childhood trauma is not associated with own SUD, but parental SUD (HR=1.556, SE=.238, p < 0.01), and early onset mood or anxiety disorder (HR=1.682, SE=.316, p < 0.01) are. For both genders, those who are African American have lower risk of SUD than those who are White (HR=0.774, SE=.109, p < 0.05 for women; HR=0.672, SE=.079, p < 0.01 for men). CONCLUSIONS: Parental SUD is associated with a substantial increase in risk for own SUD, and this association differs by gender and early trauma.

Newcomers and Old Timers: An Erroneous Assumption in Mental Health Services Research.

Based on the premise that treatment changes people in ways that are consequential for subsequent treatment-seeking, we question the validity of an unrecognized and apparently inadvertent assumption in mental health services research conducted within a psychiatric epidemiology paradigm. This homogeneity assumption statistically constrains the effects of potential determinants of recent treatment to be identical for former patients and previously untreated persons by omitting treatment history or modeling only main effects. We test this assumption with data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys; the weighted pooled sample is representative of noninstitutionalized U.S. adults (18+; analytic n = 19,227). Contrary to the homogeneity assumption, some associations with recent treatment are conditional on past treatment, including psychiatric disorder and race-ethnicity-measures of need and treatment disparities, respectively. We conclude that the widespread application of the homogeneity assumption probably masks differences in the determinants of recent use between previously untreated persons and former patients.

Perceived Need for Mental Health Care: The Intersection of Race, Ethnicity, Gender, and Socioeconomic Status.

Racial/ethnic minority populations underutilize mental health services, even in the presence of psychiatric disorder, and differences in perceived need may contribute to these disparities. Using the Collaborative Psychiatric Epidemiology Surveys, we assessed how the intersections of race/ethnicity, gender, and socioeconomic status affect perceived need. We analyzed a nationally representative sample of U.S. adults (18 years or older; N=14,906), including non-Latino whites, Asian Americans, Latinos, African Americans, and Afro-Caribbeans. Logistic regressions were estimated for the total sample, a clinical need subsample (meets lifetime diagnostic criteria), and a no disorder subsample. Perceived need varies by gender and nativity, but these patterns are conditional on race/ethnicity. Men are less likely than women to have a perceived need but only among non-Latino whites and African Americans. Foreign-born immigrants have lower perceived need than U.S.-born persons, only among Asian Americans. Intersectional approaches to understanding perceived need may help uncover social processes that lead to disparities in mental health care.

Social Inequalities in Inflammation: Age Variations in Older Persons.

OBJECTIVE: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons. METHOD: Data are from the 2006/2008 Health and Retirement Study ( n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics. RESULTS: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age. DISCUSSION: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.

Depressive Symptom Trajectories, Aging-Related Stress, and Sexual Minority Stress Among Midlife and Older Gay Men: Linking Past and Present.

We concatenate 28 years of historical depressive symptoms data from a longitudinal cohort study of U.S. gay men who are now midlife and older (n = 312), with newly collected survey data to analyze trajectories of depressive symptomatology over time and their impact on associations between current stress and depressive symptoms. Symptoms are high over time, on average, and follow multiple trajectories. Aging-related stress, persistent life-course sexual minority stress, and increasing sexual minority stress are positively associated with depressive symptoms, net of symptom trajectories. Men who had experienced elevated and increasing trajectories of depressive symptoms are less susceptible to the damaging effects of aging-related stress than those who experienced a decrease in symptoms over time. Intervention efforts aimed at assisting gay men as they age should take into account life-course depressive symptom histories to appropriately contextualize the health effects of current social stressors.

Sociological inquiry into mental health: the legacy of Leonard I. Pearlin.

As a tribute to the body of work created by our late colleague Leonard I. Pearlin, this essay assesses how the evolution of the Stress Process Model, the centerpiece of his work, repeatedly reinvented sociological research on stress and mental health and explains why this model, therefore, possesses the potential to renew itself well into the future. This essay revisits some of Pearlin's seminal contributions: the original specification of the stress process and three extensions of it--the concept of stress proliferation, the formulation of the role of social structure and functioning in the stress process, and the articulation of linkages between the stress process and the life course perspective. The resultant body of work has had formative influences on the ways sociologists now think about the impact of society on the inner emotional lives of its members.

Family Influences on the Use of Mental Health Services among African Americans.

We examine how families influence mental health service (MHS) utilization among African Americans by drawing on the concept of family ambivalence, which encompasses both family support and stress, and by placing utilization within the context of family histories of psychiatric disorder and treatment. Data are from the 2001-2003 National Survey of American Life, a nationally representative sample of African American adults (n = 3,149), including a clinical need subsample (n = 605) of respondents with a disorder. Negative family interactions have indirect positive effects on use of any MHS through need for care, whereas family social support lacks any effect. Although poor self-rated mental health (SRMH) is associated with greater utilization of any and specialty MHS given family histories of no disorder or treated disorder, utilization is low given a family history of untreated disorder, irrespective of SRMH. Screening for family histories of psychiatric disorder in primary care is recommended.

Social status attainment during the transition to adulthood.

The transition from adolescence to adulthood is a critical time for status attainment, with income, education, work experience, and independence from parents accruing at varying speeds and intensities. This study takes an intergenerational life-course perspective that incorporates parents' and one's own social status to examine the status attainment process from adolescence into adulthood in the domains of economic capital (e.g., income) and human capital (e.g., education, occupation). Survey data from three waves of the National Longitudinal Study of Adolescent Health (analytic n = 8,977) are analyzed using latent class analysis to capture the ebb and flow of social status advantages and disadvantages from adolescence (Wave 1) through young adulthood (Wave 3) into adulthood (Wave 4). The analytic sample is composed of 50.3 % females and 70.2 % Whites, 15.3 % Blacks, 11.0 % Hispanics, and 3.5 % Asians ages 12-18 at Wave 1 and 25-31 at Wave 4. Four latent classes are found for economic capital and five for human capital. The importance of parents' social status is demonstrated by the presence of large groups with persistently low and persistently high social status over time in both domains. The capacity of individuals to determine their own status, however, is shown by equally large groups with upward and downward mobility in both domains. These findings demonstrate the dynamic nature of social status during this critical developmental period.

Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults.

BACKGROUND: Little is known about how a neighbourhood's unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed. METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood's unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models. RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood's unemployment history. CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

The urban neighborhood and cognitive functioning in late middle age.

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

Urban Neighborhoods and Depressive Symptoms in Late Middle Age.

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.

Depressive symptoms, chronic diseases, and physical disabilities as predictors of cognitive functioning trajectories in older Americans.

OBJECTIVES: To determine the concurrent influence of depressive symptoms, medical conditions, and disabilities in activities of daily living (ADLs) on rates of decline in cognitive function of older Americans. DESIGN: Prospective cohort. SETTING: National population based. PARTICIPANTS: A national sample of 6,476 adults born before 1924. MEASUREMENTS: Differences in cognitive function trajectories were determined according to prevalence and incidence of depressive symptoms, chronic diseases, and ADL disabilities. Cognitive performance was tested five times between 1993 and 2002 using a multifaceted inventory examined as a global measure (range 0-35, standard deviation (SD) 6.0) and word recall (range 0-20, SD 3.8) analyzed separately. RESULTS: Baseline prevalence of depressive symptoms, stroke, and ADL limitations were independently and strongly associated with lower baseline cognition scores but did not predict future cognitive decline. Each incident depressive symptom was independently associated with a 0.06-point lower (95% confidence interval (CI)=0.02-0.10) recall score, incident stroke with a 0.59-point lower total score (95% CI=0.20-0.98), each new basic ADL limitation with a 0.07-point lower recall score (95% CI=0.01-0.14) and a 0.16-point lower total score (95% CI=0.07-0.25), and each incident instrumental ADL limitation with a 0.20-point lower recall score (95% CI=0.10-0.30) and a 0.52-point lower total score (95% CI=0.37-0.67). CONCLUSION: Prevalent and incident depressive symptoms, stroke, and ADL disabilities contribute independently to poorer cognitive functioning in older Americans but do not appear to influence rates of future cognitive decline. Prevention, early identification, and aggressive treatment of these conditions may ameliorate the burdens of cognitive impairment.

Urban neighborhood context and mortality in late life.

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults. METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census. RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic. DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors.

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7's, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0-35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95% confidence interval: 3.8, 4.4) and in recall score (range, 0-20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

Urban neighborhood context and change in depressive symptoms in late life.

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms. METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models. RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics. CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

Toward explaining mental health disparities.

Mental health disparities refer to the disproportionate amount of psychopathology found among persons of disadvantageous social standing, such as persons of low socioeconomic status (SES). Although social and self selection cannot entirely be ruled out as explanations for these differences, the accumulation of evidence supports a social causation interpretation for a large portion of this association for many disorders. The stress process model is applied to understand how social inequities become mental health disparities. Data from the Los Angeles Depression Study, originated by Leo Reeder are used to illustrate the key idea that explicit causal models are essential to the development of programmatic interventions to alleviate mental health disparities, as distinct from interventions to improve mental health in general. In light of recent work on neighborhood stratification and mental health, I advocate the modification of the social contexts of the stress process.

A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life.

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

Urban neighborhoods and depressive symptoms among older adults.

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older. METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models. RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population. DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

Urban neighborhood context, educational attainment, and cognitive function among older adults.

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.